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Jan 17 02 0b: 38p H� er i n&Chr k st: I i 4�td'- -uLiur= N. � <br /> 02%15/2002 14:42 4640138 ENVIRONMENTAL HEALTH PAGE 01 <br /> SAN JOAQUIN COUNTYPU13LIC HEALTH SERVICES CHDSOGNUMBER <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 10 e -r Sy 10 ta,• BUSINESS/AGENCY LIC- <br /> ADDRESS <br /> I S r <br /> ADDRESS <br /> '25' �sr l "5-5."-"^" 14,,e. San �a uc <br /> PHONE S {tvD - 7 7O FACSIMILE �S <br /> TENTATIVE*APPOINTMENT DATE <br /> (Please give 77 tto'10 business days from date of applicat on submittal) r <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 E f QUEST PROCESSED IN 313USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USI?ONLY - <br /> PROGRAM ELEMENTS SI;.4RCH <br /> ,3 5 ery k vc L,%,,e- 4 n / S Z (� <br /> 0 W rl� zu G La a <br /> Y 4rrlc•7xu.L Let LaeC,' 3S <br /> f <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SIVE(LOP) a HOUSING ABATEMENT In SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) d FOOD FACILITY ❑ SOLID WASTE VEHIC„E <br /> ❑ UNDERGROUND TANK(MON1TORMIKEMOVAL) EO DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKPN RARCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY Q MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PE:IRCING ❑ POOUSPA E7 LAND USE APPLICAT ON ST FES <br /> O MEDICAL WASTE FACILITY ❑ PURLIC WATER SYSTEM 4 OTHER(PLEASE SPE: IFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At feast one file type MUST be selected. Fax to (209) 464-013T or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be C 7nfirmed <br /> approximately five business days but no later than ten(10)days after receipt of appliciition. The files <br /> will be held for a maximum of five business days for review. Appointments should be:scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the fila is available. <br /> 4. Any fife not returned in the same condition as released will be reorganized by EHD Mafj at the expense <br /> Of the applicant. Future file reviews by the Same applicant may require a$89.00 deposle prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications rcceived after 3:00 pm will bo processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRM15D PHONE FAX INITIALS _ <br /> REVIEWED YES NO REVIEW DATE <br />